Billroth-II Modified Versus Roux-en-Y After Distal Gastrectomy for Gastric Cancer

NCT ID: NCT05344339

Last Updated: 2025-01-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

320 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-10-08

Study Completion Date

2028-12-31

Brief Summary

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There are Billroth-I, Billroth-II, Billroth-II with Braun, and Roux-en-Y reconstruction after distal gastrectomy.

Hypothesis: Billroth-II modified method is non-inferior to Roux-en-Y method in terms of reducing reflux esophagitis after distal gastrectomy for gastric cancer patients.

Detailed Description

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Since the first gastrectomy by Theodore Billroth in 1881, this procedure remained a curative treatment for gastric cancer. Reconstruction method after gastrectomy may affect complication rates, post-operative nutritional status, and quality of life (QoL). There are several reconstruction methods for distal gastrectomy, including Billroth I (B-I), Billroth II (B-II), Roux-en-Y (R-Y). B-I and B-II were considered better than R-Y in terms of shorten operation time and lessen blood loss due to technical simplicity. In contrast, R-Y was better in terms of preventing bile reflux and remnant gastritis, which can increase remnant stomach cancer and worsen QoL. However, long term QoL was similar between B-I and R-Y in some randomized controlled trials. Although bile reflux was higher in B-I and B-II groups, remnant gastric cancer was similar between 3 groups in this study. In brief, which one is the ideal reconstruction after distal gastrectomy is still controversial.

At our center, reconstruction after distal and sub-total gastrectomy including B-I, B-II, B-II with Braun anastomosis, and R-Y, depended mostly on surgeons' preferences. From 2018, to decrease bile reflux rate while not increasing operation time, we applied modified B-II technique with 3-5 sutures between the afferent loop to the gastric remnant. This study was conducted to evaluate the efficacy of this method by comparing it with the R-Y method.

Conditions

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Gastric Cancer Distal Gastrectomy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Open label randomized control trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Billroth-II modified

An opening will be made at jejunum 25 cm from Treitz's ligament. Another at greater curvature of the stomach right above transected line. A straight stapling device will be used to make isoperistaltic anastomosis at posterior wall of the stomach. After checking for bleeding, common entry hole will be closed using running suture and 3 -5 sutures to attach afferent loop to the remnant stomach

Group Type EXPERIMENTAL

Distal gastrectomy

Intervention Type PROCEDURE

Reconstruction after Distal Gastrectomy

Roux-en-Y

Jejunum will be transected 25 to 30 cm from Treitz's ligament. Marginal vessels will be transected if needed to make sure the loop will reach the stomach without tension. Isoperistaltic gastrojejunostomy will be made at posterior wall of the stomach. After checking for bleeding, common entry hole will be closed using running suture. Jejunojejunal mesenteric defect and Petersen's defect will be closed.

Group Type ACTIVE_COMPARATOR

Distal gastrectomy

Intervention Type PROCEDURE

Reconstruction after Distal Gastrectomy

Interventions

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Distal gastrectomy

Reconstruction after Distal Gastrectomy

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients confirmed with gastric cancer
* Indicated for radical distal gastrectomy (cT1 to cT4a, any N, M0; according to AJCC/UICC 8th TNM staging for gastric cancer)
* Age from 18- to 80-year-old
* Agreed to participate in study with written inform consent

Exclusion Criteria

* Pregnant patients
* An American Society of Anesthesiology (ASA) score of higher than 4
* Concurrent cancer or history of previous other cancers
* Previous gastrectomy
* Complications including bleeding, perforation required emergency gastrectomy
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Medical Center Ho Chi Minh City (UMC)

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Long D Vo, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University Medical Center HCMC, VN

Locations

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University Medical Center Ho Chi Minh City

Ho Chi Minh City, , Vietnam

Site Status RECRUITING

Countries

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Vietnam

Central Contacts

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Long D. Vo, MD PhD

Role: CONTACT

+84918133915

Thong Q. Dang, MD, MSc

Role: CONTACT

+84333997861

Facility Contacts

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Long D. Vo, MD.

Role: primary

+84918133915

L D.

Role: backup

Other Identifiers

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15/GCN-HDDD

Identifier Type: -

Identifier Source: org_study_id

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